Services or procedures required pre - Authorization


Providers are responsible for verifying recipient eligibility and authorization requirements before providing services/products (the Authorization Department does not handle recipient eligibility inquiries.)

Common services that require authorization are:
Non-emergency hospital admission (e.g., psychiatric, rehabilitation, detoxification)
Outpatient surgical procedure Residential Treatment Center admission
Non-emergency transfer between acute facilities
In-house transfer to a rehabilitation unit
In-house transfer to and from medical and psychiatric/substance abuse units, and between psychiatric and
substance abuse units
Rollover admission from observation and same-day-surgery services
Psychologist services
Some diagnostic tests Services provided out-of-state or outside catchment areas
Physical/Occupational/Speech therapy
Home Health services
Durable Medical Equipment

An approved authorization does not guarantee the claims payment so continue your follow up.

Now a days authorization can be requested through online as well by phone conversation.

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